Dealing with depression

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(NC)-The popular first line of defence for people suffering from depression are anti-depressant drugs. In fact, with some 6% of Canadians taking antidepressants, it's become the mental health version of the old cliché "Take two aspirins and call me in the morning."

But new research is challenging this approach. When it comes to treating depression, one size just doesn't fit all, says Dr. Scott Patten, a psychiatrist and professor at the University of Calgary. "The health system needs to deliver a spectrum of treatments that includes a range of options," he says.

It's estimated that the number of people with clinical depression being treated with antidepressants soared from 15-20% in the early nineties to 50% today. "For physicians, who are the largest prescribers of antidepressants, they're the preferred treatment because they require less time and less specialized training."

But Patten argues it's time to move to the next level in terms of the sophistication of how we treat depression. "There are a lot of areas where fine-tuning needs to be done, areas where Canada is falling behind other countries."

Using data from Statistics Canada, pharmaceutical companies and his own surveys in Alberta, Patten has found that the frequency, severity, and duration of depression varies greatly, as does the response to different treatments.

For example, his work, supported by the Canadian Institutes of Health Research, suggests that if you get depressed tomorrow, you have quite a high probability of recovering in a few of weeks. "This means some people who come down with depression might not need any treatment, because it will soon go away on its own."

But, with each passing week you remain depressed, your chances of recovering without treatment typically get smaller and smaller. Even then, those with milder and shorter episodes of depression may often need short-term psychological orientation rather than pharmaceuticals, he says.

At the other end of the spectrum are people with severe ongoing depression. For these patients, he argues, the medical community should be taking a longer-term, team approach. If antidepressants are prescribed and the depression subsides or disappears, it shouldn't be the end of treatment. Instead, severe depression should be treated in much the same way diabetes or hypertension are. "There should be a more proactive disease management strategy where a team follows people closely and optimizes their individual treatment," he says.

Patten adds specific advice for family doctors. "If I was a family doctor, I might need to expand my primary care network to make sure I can get good, quick access to short-term psychotherapy, have lots of information and resources I can give to people with early and mild depression, and have good referral connections for those with more severe forms that need more proactive ongoing management."